Healthcare Provider Details

I. General information

NPI: 1659948685
Provider Name (Legal Business Name): ERNESTO AMERICO PEREZ COLOME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 08/28/2023
Certification Date: 04/05/2023
Deactivation Date: 04/05/2023
Reactivation Date: 08/28/2023

III. Provider practice location address

11750 BIRD ROAD
MIAMI FL
33175
US

IV. Provider business mailing address

11750 BIRD ROAD
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-3000
  • Fax: 305-227-5556
Mailing address:
  • Phone: 305-223-3000
  • Fax: 305-227-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: